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Introduction: In Intensive Care Units, oral hygiene is a care action directly related to the safety and well-being of the patient, being one of the main ways of preventing Pneumonia Associated with Mechanical Ventilation. Although relevant, the recommendations and standardization on oral hygiene among critically ill patients are diffuse. Objective: To construct and validate a standard operating procedure (SOP) for oral hygiene performed by the nursing team for intubated and tracheostomized patients in an Intensive Care Unit (ICU). Methods: Methodological study developed in five stages: technical-scientific support; construction of SOP; recruitment and selection of experts; validation and presentation of the final version. The SOP was subjected to validation by judges with academic and/or clinical expertise (n=13) from all regions of Brazil, who assessed the validity criteria for each SOP item: Scope, Clarity, Coherence, Criticism, Objectivity, Scientific writing; Relevance, Sequence, and Uniqueness. The Content Validity Indices (CVI) of each validity criterion, SOP item, and the general CVI were calculated. Results: The experts were nurses (38.5%), dentists (38.5%), doctors (15.4%) and physiotherapists (7.7%). None of the SOP items had a CVI lower than 0.80. The general CVI was 0.95 and the experts' suggestions were mostly accepted (78.6%). The final version is available as an infographic, which illustrates the stages of the oral hygiene process of the intubated and tracheostomized patient. Conclusion: The constructed SOP has a satisfactory face and content validity, making a final total of 43 items to be used for oral hygiene of intubated and tracheostomy patients.
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Yurdanur DE, Yagmur FN. A recent view and evidence-based approach to oral care of intensive care patient. Int J Caring Sci. 2016;9(2):1177-84.
Nogueira JWS, Jesus CAC. Higiene bucal no paciente internado em unidade de terapia intensiva: revisão integrativa. Rev Eletr Enferm. 2017;19:a46. https://doi.org/10.5216/ree.v19.41480
Brasil. Agência Nacional de Vigilância Sanitária (ANVISA). Medidas de prevenção de infecção relacionada à assistência à saúde. Available from: https://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes/item/caderno-5.
Li Y, Yan C, Li J, Wang Q, Zhang J, Qiang W, et al. A nurse-driven enhanced recovery after surgery (ERAS) nursing program for geriatric patients following lung surgery. Thorac Cancer. 2020;11(4):1105-13. https://doi.org/10.1111/1759-7714.13372
Maran E, Spigolon DN, Matsuda LM, Teston EF, Oliveira JLC, Souza VS, et al. Efeitos da utilização do bundle na prevenção de pneumonia associada à ventilação mecânica: revisão integrativa. Rev Cuid. 2020;12:e1110. https://doi.org/10.15649/cuidarte.1110
Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020;46(5):888-906. https://doi.org/10.1007/s00134-020-05980-0
Baptista IMC, Martinho FC, Nascimento GG, Santos CER, Prado RF, Valera MC. Colonization of oropharynx and lower respiratory tract in critical patients: Risk of ventilator-associated pneumonia. Arch Oral Biol. 2018;85:64-9. https://doi.org/10.1016/j.archoralbio.2017.09.029
Manger D, Walshaw M, Fitzgerald R, Doughty J, Wanyonyi KL, White S, et al. Evidence summary: the relationship between oral health and pulmonary disease. Br Dent J. 2017;222(7):527-33. https://doi.org/10.1038/sj.bdj.2017.315
Zhang TT, Tang SS, Fu LJ. The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. J Clin Nurs. 2014;23(11-12):1461-75. https://doi.org/10.1111/jocn.12312
Snyders O, Khondowe O, Bell J. Oral chlorhexidine in the prevention of ventilator-associated pneumonia in critically ill adults in the ICU: a systematic review. Southern African J Crit Care. 2011;27(2):48-56. https://doi.org/10.7196/SAJCC.123
Chlebicki MP, Safdar N. Topical chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Crit Care Med. 2007;35(2):595-602. https://doi.org/10.1097/01.CCM.0000253395.70708.AC
Associação de Medicina Intensiva Brasileira (AMIB). Procedimento Operacional Padrão (POP) de higiene bucal em pacientes internados em UTI adulto ou pediátrica. Available from: https://www.amib.org.br/fileadmin/user_upload/amib/2019/novembro/29/2019_POP-HB_em_papel-carta_AMIB.pdf
Empresa Brasileira de Serviços Hospitalares (EBSERH). Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (UFTM). Procedimento Operacional de Padrão Higiene Bucal. Available from: https://www.gov.br/ebserh/pt-br/hospitais-universitarios/regiao-sudeste/hc-uftm/documentos/pops/pop-atendimento-odontologico-nas-utis-final-docx.pdf
Franco JB, Jales SMCP, Zambon CE, Fujarra FJC, Ortegosa MV, Guardieiro PFR, et al. Higiene bucal para pacientes entubados sob ventilação mecânica assistida na unidade de terapia intensiva: proposta de protocolo. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo. 2014;59(3):126-31.
Blum DFC, Silva JAS, Baeder FM, Bona AD. The practice of dentistry in intensive care units in Brazil. Rev Bras Ter Intensiva. 2018;30(3):327-32. https://doi.10.5935/0103-507X.20180044
Sales CB, Bernardes A, Gabriel CS, Brito MFP, Moura AA, Zanetti ACB. Standard Operational Protocols in professional nursing practice: use, weaknesses and potentialities. Rev Bras Enferm. 2018;71(1):126-34. https://doi.org/10.1590/0034-7167-2016-0621
Nasiriani K, Torki F, Jarahzadeh MH, Maybodi FR. The effect of Brushing with a Soft Toothbrush and Distilled Water on the Incidence of Ventilator-Associated Pneumonia in the Intensive Care Unit. Tanaffos. 2016;15(2):101-7.
Vidal CFL, Vidal AK, Monteiro Jr JGM, Cavalcanti A, Henriques APT, Oliveira M, et al. Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC Infect Dis. 2017;17:112. https://doi.org/10.1186/s12879-017-2188-0
Zhao T, Wu X, Zhang Q, Li C, Worthington HV, Hua F. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2020;24;12:CD008367. https://doi.org/10.1002/14651858.CD008367.pub4
Melnyk BM, Fineout-Overholt E. Making the case for evidence-based practice. In: Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing & healthcare. A guide to best practice. 3rd ed. Philadelphia: Lippincot Williams & Wilkins, 2005.
Polit DF, Beck CT. Fundamentos de pesquisa em enfermagem. Porto Alegre: Artmed, 2019.
Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Cienc Saude Coletiva. 2011;16(7):3061-8. https://doi.org/10.1590/S1413-81232011000800006
Catunda HLO, Bernardo EBR, Vasconcelos CTM, Moura ERF, Pinheiro AKB, Aquinos PS. Percurso metodológico em pesquisas de enfermagem para construção e validação de protocolos. Texto Contexto Enferm. 2017;26(2):e00650016. https://doi.org/10.1590/0104-07072017000650016
Pasquali L. Instrumentação psicológica: fundamentos e práticas. Porto Alegre: Artmed, 2010.
Support Frontline Healthcare Workers Infographic_new. Procedimento Operacional Padrão Para Higienização Bucal de Pacientes Intubados e Traqueostomizados. Available from: https://venngage.net/ps/g6TxFxziQc/support-frontline-healthcare-workers-infographic_new
Urisman T, Garcia A, Harris HW. Impact of surgical intensive care unit interdisciplinary rounds on interprofessional collaboration and quality of care: Mixed qualitative-quantitative study. Intensive Crit Care Nurs. 2018;44:18-23. https://doi.org/10.1016/j.iccn.2017.07.001
Klompas M, Speck K, Howell MD, Greene LR, Berenholtz SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med. 2014;174(5):751-61. https://doi.org/10.1001/jamainternmed.2014.359
Price R, MacLennan G, Glen J. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ. 2014;348:g2197. https://doi.org/10.1136/bmj.g2197
Warren C, Medei MK, Wood B, Schutte D. A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia. Am J Nurs. 2019;119(2):44-51. https://doi.org/10.1097/01.NAJ.0000553204.21342.01
Marino PJ, Hannigan A, Haywood S, Cole JM, Palmer N, Emanuel C, et al. Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study. BMJ Open Respir Res. 2016;3(1):e000150. https://doi.org/10.1136/bmjresp-2016-000150
Berry AM, Davidson PM. Beyond comfort: oral hygiene as a critical nursing activity in the intensive care unit. Intensive Crit Care Nurs. 2006;22(6):318-28. https://doi.org/10.1016/j.iccn.2006.04.003
Nakahodo N, Nomura Y, Oshiro T, Otsuka R, Kakuta E, Okada A, et al. Effect of Mucosal Brushing on the Serum Levels of C-Reactive Protein for Patients Hospitalized with Acute Symptoms. Medicina (Kaunas). 2020;56(10):549. https://doi.org/10.3390/medicina56100549
Coleman P. Improving oral health care for the frail elderly: A review of widespread problems and best practices. Geriatric Nurs. 2002;23(4):189-99. https://doi.org/10.1067/mgn.2002.126964
Dwivedi V, Torwane NA, Tyagi S, Maran S. Effectiveness of various tongue cleaning aids in the reduction of tongue coating and bacterial load: a comparative clinical study. J Contemp Dent Pract. 2019;20(4):444-8.
Soussan R, Schimpf C, Pilmis B, Degroote T, Tran M, Bruel C, et al. Ventilator-associated pneumonia: the central role of transcolonization. J Crit Care. 2019;50:155-61. https://doi.org/10.1016/j.jcrc.2018.12.005
Tarihi Y. Erişkin Yoğun Bakım Hastalarında Temel Sorunlar ve Hemşirelik Bakımı. Istanbul: Nobel TipKitabevleri, 2014.
Özveren H, Uçar H. Efeitos da higiene bucal fornecida com três ferramentas diferentes em pacientes recebendo ventilação mecânica. J Hum Sci. 2017;14(4):4507-19. https://doi.org/10.14687/jhs.v14i4.4948
Abidia RF. Oral care in the intensive care unit: a review. J Contemp Dent Pract. 2007;8(1):76-82.